Table 1.

ACT-SS Manual Content.

Major Content Areas of ACT-SS
Identifying Problems with Social Avoidance	Veterans are asked to identify efforts to avoid interpersonal experiences and how this is problematic for developing and maintaining relationships
Identifying Triggers	Interpersonal triggers are identified, with an emphasis on how PTSD-related triggers and symptoms are related to interpersonal conflict and avoidance.
Acceptance and Mindfulness	Veterans participate in mindfulness exercises in order to practice nonjudgmental acceptance of interpersonal experiences and PTSD symptoms that interfere with interpersonal interactions (e.g., irritability and feelings of detachment).
Valued Living	Veterans clarify their values and goals (i.e., reasons for changing patterns in interpersonal experiences), and identify barriers (thoughts, feelings, sensations associated with PTSD) that prevent them from achieving these goals.
Cognitive Defusion	Veterans learn that partners, family members, and peers are not threats to their safety and to mindfully observe anxieties about social interactions.
Willingness Exercises	Veterans create exposure hierarchies for social interactions and face them with mindful acceptance to become more comfortable with these experiences.
Committed Action	Veterans incorporate more social activities in their lives and opportunities to interact with others that are consistent with valued goals. Veterans commit to spending more time with important social supports and develop new relationships.
Specific Content Areas to Address for Veterans with PTSD in ACT-SS
Social Isolation	Goals focus on being willing to engage in social interactions and increasing community involvement, while accepting PTSD-related symptoms.
Building Healthy Relationships	Ask veterans to be present, validate the other person, be compassionate, share valued activities, and practice connection.
Anger	Veterans learn to be more mindful of anger and choose to act according to their values.
Trust	Veterans balance values around trust with values around self-protection and practice mindful trusting—be aware of the person’s behavior and provide trust when it is earned.